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  • 1
    In: Orphanet Journal of Rare Diseases, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2021-12)
    Abstract: The Gaucher Investigative Therapy Evaluation is a national clinical cohort of 250 patients aged 5–87 years with Gaucher disease in the United Kingdom—an ultra-rare genetic disorder. To inform clinical decision-making and improve pathophysiological understanding, we characterized the course of Gaucher disease and explored the influence of costly innovative medication and other interventions. Retrospective and prospective clinical, laboratory and radiological information including molecular analysis of the GBA 1 gene and comprising  〉  2500 variables were collected systematically into a relational database with banking of collated biological samples in a central bioresource. Data for deep phenotyping and life-quality evaluation, including skeletal, visceral, haematological and neurological manifestations were recorded for a median of 17.3 years; the skeletal and neurological manifestations are the main focus of this study. Results At baseline, 223 of the 250 patients were classified as type 1 Gaucher disease. Skeletal manifestations occurred in most patients in the cohort (131 of 201 specifically reported bone pain). Symptomatic osteonecrosis and fragility fractures occurred respectively in 76 and 37 of all 250 patients and the first osseous events occurred significantly earlier in those with neuronopathic disease. Intensive phenotyping in a subgroup of 40 patients originally considered to have only systemic features, revealed neurological involvement in 18: two had Parkinson disease and 16 had clinical signs compatible with neuronopathic Gaucher disease—indicating a greater than expected prevalence of neurological features. Analysis of longitudinal real-world data enabled Gaucher disease to be stratified with respect to advanced therapies and splenectomy. Splenectomy was associated with an increased hazard of fragility fractures, in addition to osteonecrosis and orthopaedic surgery; there were marked gender differences in fracture risk over time since splenectomy. Skeletal disease was a heavy burden of illness, especially where access to specific therapy was delayed and in patients requiring orthopaedic surgery. Conclusion Gaucher disease has been explored using real-world data obtained in an era of therapeutic transformation. Introduction of advanced therapies and repeated longitudinal measures enabled this heterogeneous condition to be stratified into obvious clinical endotypes. The study reveals diverse and changing phenotypic manifestations with systemic, skeletal and neurological disease as inter-related sources of disability.
    Type of Medium: Online Resource
    ISSN: 1750-1172
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 2
    Online Resource
    Online Resource
    Elsevier BV ; 2011
    In:  Ophthalmology Vol. 118, No. 4 ( 2011-04), p. 794-794.e1
    In: Ophthalmology, Elsevier BV, Vol. 118, No. 4 ( 2011-04), p. 794-794.e1
    Type of Medium: Online Resource
    ISSN: 0161-6420
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2011
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  • 3
    In: Neuromuscular Disorders, Elsevier BV, Vol. 28, No. 4 ( 2018-04), p. 346-349
    Type of Medium: Online Resource
    ISSN: 0960-8966
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2008287-3
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  • 4
    In: Calcified Tissue International, Springer Science and Business Media LLC, Vol. 111, No. 4 ( 2022-08-04), p. 409-418
    Type of Medium: Online Resource
    ISSN: 1432-0827
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1458487-6
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  • 5
    Online Resource
    Online Resource
    Wiley ; 2011
    In:  Journal of Inherited Metabolic Disease Vol. 34, No. 2 ( 2011-04), p. 449-454
    In: Journal of Inherited Metabolic Disease, Wiley, Vol. 34, No. 2 ( 2011-04), p. 449-454
    Abstract: There is no evidence that high phenylalanine (Phe) levels have irreversible effects on the adult brain. Many adults with phenylketonuria (PKU) no longer follow a protein‐restricted diet. Neuropsychological studies have shown that reaction time in adults with PKU is slower than controls. There are no data to show that this is directly related to Phe levels. Another way to assess reaction time is to measure saccadic latency. We have used a portable, head‐mounted saccadometer to measure latency in the outpatient setting. Patients with PKU were split into three groups: off‐diet (Phe 〉 1,200 μmol/l), on‐diet (Phe 〈 800 μmol/l) and maternal diet (Phe 100–400 μmol/l ). Reciprocal median latency (RML) was compared between groups. Latency was significantly slower in patients who were off‐diet than in patients on‐diet, on a maternal diet or in normal controls. Reaction times in both diet‐treated groups were not significantly different from normal controls. In 16 women planning pregnancy we obtained values before and after they commenced the maternal diet. Stricter control of Phe levels resulted in a significant improvement in reaction times. We conclude that saccadometry is useful in monitoring PKU patients. Adult patients with PKU not on a protein‐restricted diet have significantly slower reaction times than controls. In addition, off‐diet patients have significantly slower reaction times than on‐diet. Paired data show that effects of Phe levels on reaction time are reversible.
    Type of Medium: Online Resource
    ISSN: 0141-8955 , 1573-2665
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2011
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  • 6
    Online Resource
    Online Resource
    Wiley ; 2014
    In:  Journal of Inherited Metabolic Disease Vol. 37, No. 2 ( 2014-03), p. 177-187
    In: Journal of Inherited Metabolic Disease, Wiley, Vol. 37, No. 2 ( 2014-03), p. 177-187
    Abstract: Fabry disease, an X‐linked lysosomal storage disorder, leads to multi‐organ dysfunction, including cerebrovascular disease and psychological disorders. However, the prevalence and pattern of associated cognitive dysfunction is not well understood. Objectives To investigate whether there is reliable evidence for neuropsychological impairment in patients with Fabry disease and which cognitive domains are affected. To estimate the prevalence of and factors associated with depression in patients with Fabry disease. Method Qualitative systematic review of the literature of studies conducting neuropsychological assessment or measuring the prevalence of depression in adults with Fabry disease using the preferred reporting items for systematic reviews and meta‐analysis (PRISMA) guidelines where appropriate. Results There is some evidence for neuropsychological impairment in Fabry disease in executive functioning, information processing speed and attention, with preservation of: general intellectual functioning, memory, naming, perceptual functioning and global cognitive functioning. Prevalence rates of depression in Fabry disease ranged from 15 % to 62 %, with the largest study to date reporting a prevalence rate of 46 %. The most common factor associated with depression was neuropathic pain, both directly and indirectly by affecting social and adaptive functioning. Conclusion Our review suggests that Fabry disease may be associated with a characteristic pattern of cognitive deficits and a high prevalence of psychological disorders such as depression but highlights the limited available data. Exploring the nature of cognitive impairment in Fabry disease using standardised neuropsychological assessment, brain imaging and measures of depression is an important task for future research.
    Type of Medium: Online Resource
    ISSN: 0141-8955 , 1573-2665
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 7
    In: Journal of Inherited Metabolic Disease, Wiley, Vol. 41, No. 5 ( 2018-09), p. 829-838
    Abstract: Olipudase alfa, a recombinant human acid sphingomyelinase (ASM), is an enzyme replacement therapy for the treatment of nonneurologic manifestations of acid sphingomyelinase deficiency (ASMD). This ongoing, open‐label, long‐term study (NCT02004704) assessed safety and efficacy of olipudase alfa following 30 months of treatment in five adult patients with ASMD. There were no deaths, serious or severe events, or discontinuations during 30 months of treatment. The majority of adverse events were mild and included headache, nausea, and abdominal pain. No patient developed anti‐drug antibodies and there were no clinically significant adverse changes in vital signs, hematology, or cardiac safety parameters. Statistically significant reductions in liver (31%) and spleen (39%) volumes were maintained through 30 months of treatment. There was a mean increase in lung diffusing capacity of 35%, and clinically relevant improvements in infiltrative lung disease parameters. Lipid profiles improved in all patients. Improvements in bone mineral density of the spine were observed in some patients. Chitotriosidase in serum and lyso‐sphingomyelin in dried blood spots decreased with olipudase alfa treatment, suggesting utility as biomarkers for monitoring treatment efficacy. Olipudase alfa is the first etiology‐specific treatment in development for ASMD. This study demonstrates that treatment with olipudase alfa for 30 months is well‐tolerated and associated with life‐transforming sustained improvements in relevant disease clinical measures.
    Type of Medium: Online Resource
    ISSN: 0141-8955 , 1573-2665
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 8
    In: Journal of Inherited Metabolic Disease, Wiley, Vol. 37, No. 1 ( 2014-01), p. 21-30
    Abstract: Urea cycle disorders (UCDs) are inherited disorders of ammonia detoxification often regarded as mainly of relevance to pediatricians. Based on an increasing number of case studies it has become obvious that a significant number of UCD patients are affected by their disease in a non‐classical way: presenting outside the newborn period, following a mild course, presenting with unusual clinical features, or asymptomatic patients with only biochemical signs of a UCD. These patients are surviving into adolescence and adulthood, rendering this group of diseases clinically relevant to adult physicians as well as pediatricians. In preparation for an international workshop we collected data on all patients with non‐classical UCDs treated by the participants in 20 European metabolic centres. Information was collected on a cohort of 208 patients 50% of which were ≥ 16 years old. The largest subgroup (121 patients) had X‐linked ornithine transcarbamylase deficiency (OTCD) of whom 83 were female and 29% of these were asymptomatic. In index patients, there was a mean delay from first symptoms to diagnosis of 1.6 years. Cognitive impairment was present in 36% of all patients including female OTCD patients (in 31%) and those 41 patients identified presymptomatically following positive newborn screening (in 12%). In conclusion, UCD patients with non‐classical clinical presentations require the interest and care of adult physicians and have a high risk of neurological complications. To improve the outcome of UCDs, a greater awareness by health professionals of the importance of hyperammonemia and UCDs, and ultimately avoidance of the still long delay to correctly diagnose the patients, is crucial.
    Type of Medium: Online Resource
    ISSN: 0141-8955 , 1573-2665
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    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 9
    Online Resource
    Online Resource
    Wiley ; 2022
    In:  Journal of Inherited Metabolic Disease Vol. 45, No. 3 ( 2022-05), p. 381-382
    In: Journal of Inherited Metabolic Disease, Wiley, Vol. 45, No. 3 ( 2022-05), p. 381-382
    Type of Medium: Online Resource
    ISSN: 0141-8955 , 1573-2665
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 10
    In: Orphanet Journal of Rare Diseases, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2022-12)
    Abstract: Individuals with glycogen storage disease IIIa (GSD IIIa) (OMIM #232400) experience muscle weakness and exercise limitation that worsen through adulthood. However, normative data for markers of physical capacity, such as strength and cardiovascular fitness, are limited. Furthermore, the impact of the disease on muscle size and quality is unstudied in weight bearing skeletal muscle, a key predictor of physical function. We aim to produce normative reference values of aerobic capacity and strength in individuals with GSD IIIa, and to investigate the role of muscle size and quality on exercise impairment. Results Peak oxygen uptake (V̇O 2 peak) was lower in the individuals with GSD IIIa than predicted based on demographic data (17.0 (9.0) ml/kg/min, 53 (24)% of predicted, p  = 0.001). Knee extension maximum voluntary contraction (MVC) was also substantially lower than age matched predicted values (MVC: 146 (116) Nm, 57% predicted, p  = 0.045), though no difference was found in MVC relative to body mass (1.88 (2.74) Nm/kg, 61% of predicted, p  = 0.263). There was a strong association between aerobic capacity and maximal leg strength (r = 0.920; p  = 0.003). Substantial inter-individual variation was present, with a high physical capacity group that had normal leg strength (MVC), and relatively high V̇O 2 peak, and a low physical capacity that display impaired strength and substantially lower V̇O 2 peak. The higher physical capacity sub-group were younger, had larger Vastus Lateralis (VL) muscles, greater muscle quality, undertook more physical activity (PA), and reported higher health-related quality of life. Conclusions V̇O 2 peak and knee extension strength are lower in individuals with GSD IIIa than predicted based on their demographic data. Patients with higher physical capacity have superior muscle size and structure characteristics and higher health-related quality of life, than those with lower physical capacity. This study provides normative values of these important markers of physical capacity.
    Type of Medium: Online Resource
    ISSN: 1750-1172
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2225857-7
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